Insomnia

Explain your symptoms or tell us how we can help today.*

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What symptoms have you been experiencing recently?*

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How Long have you been having these symptoms?*

Have you ever been treated for insomnia?*

How long ago?*

What medications were you treated with?*

Please list the treatment plan:*

Did treatment work?*

Would you prefer the same treatment?*

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Any medical family history?*

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Do you have any medical conditions?*

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Have you ever had any surgeries or recent hospitalizations?*

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